Can a facility discharge a resident to a hospital for a psych evaluation and refuse to take them back?

It sounds to me like your BIL has a psychiatric issue and not a 'dementia' issue, meaning any Memory Care facility is going to release him once they discover that fact. You may be able to put a band-aid over the current situation and buy him another 30 days at the current place, but that's not going to solve the long term issue which seems to be at play here. You need to get him properly evaluated so he can be placed where he belongs, because he's not having any success with Memory Care communities.

I work in a Memory Care and we erroneously took in a woman who's schizophrenic, as it turns out. She mimics dementia behaviors from time to time, but her overall behavior does NOT fit the 'dementia/Alheimier's' profile. Her daughter is now trying to figure out where to place her next since Memory Care is not the right fit for her.

Best of luck!

Haileybug....the bottom line is this, and it's not something you'll want to hear. These facilities make their own rules. As a residents and family members, you must abide by their rules, whether you agree with them or not, whether you find the admins to be professional about their handling of your BIL or not, you are at their mercy. Your BIL may be an 'angel' in your presence, a 'teddy bear' in the presence of the various psychiatrists and doctors he's been evaluated by, but while alone with aides and others in the MCs, he apparently changes into someone who's not an angel or a teddy bear. After a few of those incidents, the administration decides whether or not they want to continue keeping him as a resident and whether it's safe for the REST of the residents or the STAFF to have him housed there. If their answer and their determination is NO, then he is asked to leave. You may have one idea of what is 'safe' while they have another one entirely.

Remember...........these places like to keep residency at 100%.......their goal is never to 'lose' residents but to 'keep' residents. Only when it becomes 100% necessary is when a resident is asked to leave.

Best of luck finding a good location for your BIL.

Kids do get expelled from school Hailybug, or at least suspended so often they may as well be expelled.
What you don't seem to get is that even if he is an angel 90% of the time nobody wants a loose canon in a facility, the families of the other residents shouldn't have to fear for their loved ones safety because they are too demented to be wary of your BILs hot buttons and the staff shouldn't have to fear being abused verbally or physically just for the privilege of earning a (meager) paycheck.
Dementia care facilities do handle most common behaviour problems very well but there are always exceptions to the rule - unpredictable violence and/or sexually inappropriate behaviours are examples of problems too difficult for the average facility. Yes, if we all lived in a Utopian society there would be specialized one on one care for all the people in memory care, unfortunately this is the real world and if he needs one on one care somebody has to pay for it.

Hailey, when I placed my father with vascular dementia and paranoid personality disorder into a locked MC I was _very_ honest with the director about my father's aggressive personality, verbal abuse, and occasional violent behavior when he didn't get his way or someone tried to get him to do something he didn't want to do. Dad was prescribed anti-depression and anti-anxiety medications (as well as meds for other physical conditions) he didn't want take as directed so medication management was a big concern. I chose to pay for an "transition" plan where he had extra attention and a weekly assessment for his first six weeks. I shared with the staff the things I thought my father would like: the porch rocker, 24/7 kitchen and pretty nurses since Dad was always much more cooperative with doctor office and in home care staff. The director and I agreed to be as flexible as possible and not push my father to do anything he resisted unless it was absolutely necessary. So Dad stayed in his room pouting for much of the first month. Once Dad was settled in the MC and taking his medication as prescribed, there were never any major problems; however, every time he went to the hospital and returned to the MC, we paid for additional "transitional" help for a few days to a week.

During the transitions, I asked the DON to contact me every day or so (phone call or email) at _her_ convenience to let me know how Dad was doing and if there was anything I needed to do for Dad. One of the benefits of the extra transitional care was a daily report was written and the DON forwarded those to me.

I didn't try to tell the MC how to operate. When there were issues I asked what our options were. We always found something we thought would work out better, sometimes those ideas worked and sometimes we had to try again. When the plan wasn't followed as agreed, I asked about my misunderstanding of the action plan instead of starting with a confrontation. I completely understand your frustration and anger and the desire to confront the people who haven't met your expectations, but you really do need to remember "you can catch more flies with sugar than vinegar". Please try to stop being so critical of the MC, it's staff, and it's actions and try to find some way to work _with_ the MC, maybe especially when something is messed up. Often there no way to "unspill" the milk but sometimes people really appreciate someone who helps them clean up the mess without first bringing undue attention to their fault in the spill. "I don't understand how..." is often a good conversation starter.

Ask what conditions the MC would need met to reinstate BIL. Read his contract and be ready to use ask about any conflict resolution or eviction language you feel would be helpful to BIL's case, but be nice.

Hailey, I saw your follow up, that your BIL has pushed staff and will not tolerate bossiness.   Unfortunately, in an institution, residents must frequently do things on their schedule.  There is not one on one care.  You may have to look for another institution.

Haileybug I am on your side and I'm sorry because I know you're not going to like this; what's more I agree that the facility should have been a great deal quicker about liaising with your DH when problems began to emerge, I don't know why they didn't do that. But.

You moved heaven and earth to get BIL into a facility where you and DH could be more closely involved in his care. Good, I agree, I have supported you all along on that.

And yet in the first month you've visited three or four times. I'm sorry, that is nothing like enough. This was a time of huge transition for BIL, there were bound to be teething troubles, you needed to be in there monitoring his progress really closely until he had settled into a good routine. Phone calls are useless - you're talking to members of staff who realistically at that moment will be thinking "which one is he..?" while they assure you he's doing fine and he's a poppet. You were just out of the loop and things happen too fast for that to work.

If you seriously want BIL to return to this facility you will have to stop blaming them and find out exactly what happened. From there you will be able to see if the problems could have been defused or avoided, but you can only do that rationally if you first accept the possibility that maybe they couldn't, and this facility has bitten off more than it can chew. In which case, you do not want your BIL in their hands and the search will be on again; but that will be the Social Worker's problem.

When your DH spoke to the administrator on Christmas Eve, what did he say? Did he ask any questions? Has either of you attempted to reach her or her managers since?

Will the psych unit not let you visit BIL?

Key question: what does DH feel now about participating in BIL's care? Are you sure he really feels equal to this?

Hailey

My final thoughts as I would like to try and help you but I continue to be left scratching my head with your responses every time someone tries to explain how things work

- if you are in the US, you or hubs need a HIPPA release or medical POA to discuss BIL with health care providers

- please stop expecting others - the facilities - to solve the problem

I get no one wants to get involved but it takes great effort to make anything better in this situation - I know this first hand - my mother's dementia has turned her into someone I didn't know and I fought for her in order not to have her memory care facility send her out on a psych hold - how did I fight ?

I control her care - I take her to outside doctors including a neurologist and discuss med options and research the options -
this takes time and effort which you and hubs are not likely to have but the alternative is her facility would rather use their house doctor and suggest meds that will cause her to sleep all day -
there are few options for dementia with aggressive behavior

it does not matter that BIL used to be a good decent person - he now has a disease which manifests in psychosis - his brain is broken and no amount of sweet talk from staff is going to fix it or suddenly make him cooperative

we all agree that the situation is awful, care is lacking and resources are limited but if you are able please spend a bit of time today to write down three things you can do on Monday to help move the situation forward

I would guess that a lot of BIL's problems are a lack of consistent medical providers - is he bounced from facility to facility without a doctor knowing him and constantly having his meds changed ?

I'll offer up a start
- contact psych hospital social worker and ask what is protocol for diagnosis and follow up care plan and who will be providing that care - does BIL need a referral to psychiatrist or internist and will this care provider work with him in a facility ?

Hailey

sorry you and hubs are going through another difficult period with BIL especially during the holidays

I've followed your posts over time and it seems the same folks will respond to you with the same comments and questions but you don't seem to respond with more information -
mainly your question revolves around why don't memory care facilities have to take your BIL ?

the only answer is No they don't

if BIL has had several psych evaluations then his dementia (if that is his only diagnosis) must be severe - the social worker at the current psych hospital must work to find a suitable discharge

during the past 4 years, I've witnessed behavior issues from residents in mom's memory care facility -
I've seen other residents hurt and I've been hit myself on several occasions -
there is no magic memory care or way to handle or redirect these situations especially if it is a strong man -
the only solution is to heavily medicate them which means they become immobile and less volatile if not walking around

You do not need to elaborate on BIL's behaviors but I'm sure you do not want to see him hurt anyone

I understand that it is difficult to accept, but there is no cure and no memory care facility no matter how expensive or what their glossy brochure says has a magic wand to make things better - it is awful I know
the best you can do is hope he is kept comfortable, safe and fed and clean

push back on the social worker to help find a solution - this isn't a first for them

contact your local Alzheimer's association and ask for suggestions

contact your county agency on aging and ask for suggestions

I’m sorry to hear this haileybug. Back to square one for your family.

I forgot-does the state have guardianship over BIL? If so they will step up but again the possibility of him being transferred somewhere far away from his brother & your family exists again- your husband will get stuck driving to wherever he is.

Unfortunately yes his MC can discharge him if they fear he is a danger to staff or residents. I believe that is the deal breaker. Giving 30 day notice is probably not required in this situation either due to BIL’s erratic and potentially dangerous behavior. My guess is he isn’t going back there.

Again I feel bad for your husband and your family. You’ve been a great advocate for what should happen (staff trained to work 1:1 taking care of BIL) but that is not going to happen unless it’s private pay.

I will guess BIL was admitted under a behavioral contract or is currently in a probation period at the new center. As he has again exhibited inability to make proper choices & can’t control his impulses - especially since they gave him a chance when no one would - I am thinking they won’t entertain taking him back.

As another poster said, leave this to the SW and DC planners to get him placed.

I hope it it works out for you & that maybe they will give him one more chance.

Haileybug I am just about certain the staff were told to document every adverse behavior from BIL. I can also bet there is plenty of documentation already. Also centers have internal protocols to follow that are written as company policy in this situation as well for the staff to follow before they discharge.

This isn’t their first rodeo, unfortunately.